§483.65 Infection Control
(F441)
Session III
Infection Control Program
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Interpretive Guidance
§483.65 Infection Control
Interpretive Guidelines Background
 Infections are a significant source of morbidity
and mortality for nursing home residents and
account for up to half of all nursing home
resident transfers to hospitals.
 Infections occur an average of 2 to 4 times
per year for each nursing home resident.
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Burden of Infections Among
U.S. Nursing Home Residents
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Most Frequent Infections in
Nursing Home Residents
√Urinary Track
√ Respiratory
√ Skin and Soft
Tissue
Other
10%
Skin/soft
tissue
14%
UTI
41%
Respiratory
35%
Katz et al. Arch Int Med 1990
Interpretive Guidance
Other Endemic Infections in
Nursing Home Residents
Conjunctivitis
Gastroenteritis
Influenza
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Common organisms that colonize the human body (normal flora)
Mouth
• Bacteria:
• Streptococcus spp
• Strep pneumoniae
• Actinomyces
• Staph epidermidis
• Lactobacillus
• Neisseria
• Staph aureus
• Enterobacter
• Anaerobes:
• Bacteroides
• Fusobacterium
• Peptostreptococcus
• Fungi:
• Yeast
• Virus:
• Herpes simplex
Skin
• Bacteria:
• Staph epidermidis
• Corynebacterium
• Proprioni acnes
• Staph aureus
• Strep spp
• Mycobacterium
• Fungi:
• Candida
• Malassezia
• Mites:
• Demodes follicularum
In addition:
• Klebsiella
• Enterobacter
Stomach
• Lactobacilli
• Strep spp
Liver & Gallbladder
• Normally sterile
• or low numbers
anaerobes
Eye
• Staph epidermidis
• Haemophilus
Nasopharynx & Oropharynx
• Staph aureus
• Staph epidermidis
• Haemophilus
• Staph aureus
• Corynebacterium
• Neisseria
• Strep spp
• Moraxella
Intestine
• Aerobes:
•Anaerobes:
• E coli
•Bacteroides
• Klebsiella
•Fusobacterium
• Proteus
•Peptostreptococcus
• Enterococcus
•Clostridium
• Lactobacillus
• Strep spp
• Pseudomonas
• Staph epi
• Staph aureus
External Genitalia & Anterior Urethra
• Bacteria:
Vagina
• Mycoplasma
•Lactobacillus
• Ureaplasma
•Staph
• Enterococcus
•Strep
• Acinetobacter
•Gardnerella
• Anaerobes
•Yeast
• Fusobacterium
• Peptostreptococcus •Bacteroides
• Gram-negative species
The Iceberg Effect
Infected
Colonized
Interpretive Guidance
Critical Aspects of Infection
Prevention and Control
Programs include:
Recognizing and managing infections at
the time of a resident’s admission to the
facility and throughout their stay, and
Following recognized infection control
practices while providing care.
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Interpretive Guidance
Considerations:
Resident Rights
It can be difficult to promote the
individual resident’s rights and wellbeing while trying to prevent and
control the spread of infections.
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Interpretive Guidance
Components of an Infection
Prevention and Control Program
 Program
Development and
Oversight
 Policies and
Procedures
 Infection
Preventionist
 Surveillance
 Documentation
 Monitoring
 Data Analysis
 Communicable
Disease Reporting
 Education
 Antibiotic Review
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Interpretive Guidance
Program Development and
Oversight
The core focus of the program oversight is
to:
Establish goals and priorities,
Monitor program implementation and
Respond to errors, problems, other
identified issues
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Interpretive Guidance
Program Development and
Oversight
Additional Program Activities include:
Identifying roles and responsibilities during
routine implementation as well as unusual
occurrences or threats of infection, and
Defining and managing resident health
initiatives.
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Interpretive Guidance
Additional Program Activities
(cont’d)
Managing food safety, and
Providing a nursing home liaison to
work with local and state health
agencies.
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Interpretive Guidance
Personnel Responsible for
Overall Program Oversight
The facility program oversight should
collaboratively includes the:
Administrator,
Medical Director (or designee),
Director of Nursing, and
Other staff as appropriate.
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Interpretive Guidance
Policies and Procedures
Written policies establish the program’s
expectations and parameters.
Procedures guide the implementation of the
policies and performance of specific tasks.
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Interpretive Guidance
Policies and Procedures
• Serve as foundation of the IC Program
• Periodic review and revision necessary
to conform to current practice
standards or address specific-facility
concerns
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Interpretive Guidance
Infection Preventionist (IP)
IP serves as program coordinator and
responsibilities may include:
Education and training;
Collecting, analyzing, and providing
infection data and trends to nursing staff
and other healthcare practitioners; and
 Consulting on infection risk assessment,
prevention, and control strategies.
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Interpretive Guidance
Surveillance
Essential Elements
Two Types:

Process

Outcome
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Infection Surveillance:
not just for Sherlock!
Interpretive Guidance
Process Surveillance
Process surveillance reviews practices
directly related to resident care in order
to identify whether the practices are
compliant with established prevention
and control policies based on
recognized guidelines.
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Interpretive Guidance
Outcome Surveillance
• Designed to identify and report evidence
of an infectious disease
• Outcome surveillance process consists of:
– Collecting/documenting data on
individual cases;
– Comparing collected data to standard
written definitions (criteria) of infections.
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Current Surveillance for Infectious Diseases
Disease Reporting Rules
Influenza
Surveillance
General Public
Unexplained Deaths
Veterinary/Animal Health
Interpretive Guidance
Documentation
Various Approaches
• Various approaches to gathering, listing,
and documenting surveillance data
• Infection control reports must describe the
types of infections and serve to identify
trends and patterns.
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Interpretive Guidance
Monitoring
Monitoring considered an integral
part of infection control surveillance
• Program implementation, effectiveness
• Resident infection status
• Infection resolution and/or outbreak
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Interpretive Guidance
Data Analysis
Comparing past and present
surveillance data enables the
detection of unusual or unexpected:
Outcomes
Trends
Ineffective practices
Performance issues
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Interpretive Guidance
Data Analysis
The data analysis allows facility to evaluate
need to change practices such as:
Enhance infection prevention
Minimize potential for infection transmission
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Interpretive Guidance
Communicable Disease
Reporting
Each facility must have processes that
enable them to:
– Consistently comply with state and local
health department requirements for
reporting communicable diseases
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Minnesota
Communicable
Disease
Reporting
Rules
Interpretive Guidance
Staff Education
Initial and ongoing staff education/training
necessary to understand/comply with
infection control practices.
General infection control principles/practices
Addition training required:
Discipline and task-specific infection control
training
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Interpretive Guidance
Antibiotic Review
Due to increases in MDROs, review
of the use of antibiotics (including
comparing prescribed antibiotics with
available susceptibility reports) is a
vital aspect of the infection prevention
and control program.
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Antibiotics are not effective against viral infections – like the flu
or the common cold.
Taking antibiotics for viral infections contributes to antibiotic
resistance.